ACUTE-RENAL-FAILURE IN LEPTOSPIROSIS IN URUGUAY

The present study was carried out to describe epidemniology and clinic al pattern of acute renal failure caused by leptospirosis in Uruguay. For these purposes, all literature published in Uruguay was reviewed. Three studies were analyzed: 2 series of patients and 1 case report th at summarize 26 cases. The incidence of acute renal failure found in t he first study was 8% and in the second one, 15%. The first study incl uded only dialyzed patients, which could explain the aforementioned di fference. The Estimated annual incidence of leptospirosis in Uruguay i s about 10 cases/year. Therefore, the expected incidence of acute rena l failure due to leptospirosis is of 0.7-1.3 cases/year. All but 1 cas e were males. Mean age was 35 +/- 14.5. Source of infection was known in 23/26. Typical symptoms were: fever 25/26, myalgias 22/26, dehydrat ion 21/26, jaundice 21/26, conjuntival suffusion 20/26, and digestive disturbance 18/26. Bleeding and meningitis were infrequent (8/26, 5/26 , respectively). Acute renal failure was intrinsic in 18/26. Nonoligur ic forms were predominant (14/18). Kalemia was low or normal in 22/26 cases. Dialysis was performed in 9/26 cases, but the number of dialyse s per patient was high (9.4 +/- 4). The survival rate was 23/26. We co ncluded that leptospirosis is an infrequent cause of acute renal failu re in Uruguay, with an expected frequency of approximately 1 case/year . Clinical picture was typical and contact was frequently known, which made diagnosis easy. Acute renal failure was predominantly polyuric a nd with low or normal kalemia; survival rate was high.